Magnetic resonance imaging of the spine
More details
Hide details
Department of Medical Imaging, Ophthalmology and Vision Science and Neurosurgery, University of Arizona College of Medicine, USA
Department of Medical Imaging, University of Arizona College of Medicine, USA
Department of Medical Imaging and Orthopaedic Surgery, University of Arizona College of Medicine, USA
Business – SimonMed Imaging, Scottsdale, AZ, USA
Submission date: 2020-04-29
Acceptance date: 2020-07-20
Publication date: 2020-09-25
Pol J Radiol, 2020; 85: 550-574
Low back and neck pain are common and result in significant patient disability and health care expenditure. When conservative treatment fails or worrisome clinical findings are present, magnetic resonance imaging (MRI) is the imaging modality of choice to assess the cause and complicating features of spine pain. There are many potential aetiologies of spine pain with similar clinical presentation, including degenerative changes, infection, and insufficiency and pathologic fractures. MRI allows for the differentiation of these sources of spine pain and potential complicating features, permitting the appropriate direction of therapy.
Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73: 968-974.
Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet 2017; 389: 736-747.
Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med 2013; 369: 448-457.
Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health, 1996-2013. JAMA 2016; 316: 2627-2646.
Rao VM, Levin DC. The overuse of diagnostic imaging and the Choosing Wisely initiative. Ann Intern Med 2012; 157: 574-576.
Kim LH, Vail D, Azad TD, et al. Expenditures and health care utilization among adults with newly diagnosed low back and lower extremity pain. JAMA Netw Open 2019; 2: e193676.
Patel ND, Broderick DF, Burns J, et al. ACR appropriateness criteria: lower back pain. Available at:
Narrative/ (Accessed: 29.03.2020).
Nardo L, Alizai H, Virayavanich W, et al. Lumbosacral transitio­nal vertebrae: association with low back pain. Radiology 2012; 265: 497-503.
Konin GP, Walz DM. Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol 2010; 31: 1778-1786.
Peckham ME, Hutchins TA, Stilwill SE, et al. Localizing the L5 vertebra using nerve morphology on MRI: an accurate and reliable technique. AJNR Am J Neuroradiol 2017; 38: 2008-2014.
Carrino JA, Campbell PD Jr, Lin DC, et al. Effect of spinal segment variants on numbering vertebral levels at lumbar MR imaging. Radiology 2011; 259: 196-202.
Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine 1984; 9: 493-495.
Quinlan JF, Duke D, Eustace S. Bertolotti’s syndrome. A cause of back pain in young people. J Bone Joint Surg Br 2006; 88: 1183-1186.
Raj PP. Intervertebral disc: anatomy–physiology–pathophysiology–treatment. Pain Pract 2008; 8: 18-44.
Choi YS. Pathophysiology of degenerative disc disease. Asian Spine J 2009; 3: 39-44.
Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 2001; 26: 1873-1878.
Griffith JF, Wang YX, Antonio GE, et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine 2007; 32: E708-12.
Munter FM, Wasserman BA, Wu HM, et al. Serial MR imaging of annular tears in lumbar intervertebral disks. AJNR Am J Neuroradiol 2002; 23: 1105-1109.
Yu SW, Sether LA, Ho PS, et al. Tears of the anulus fibrosus: correlation between MR and pathologic findings in cadavers. AJNR Am J Neuroradiol 1988; 9: 367-370.
Modic MT, Steinberg PM, Ross JS, et al. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988; 166: 193-199.
Jenson RK, Leboeuf-Yde C, Wedderkopp N, et al. Is the development of modic changes associated with clinical symptoms? A 14-month cohort study wih MRI. Eur Spine J 2012; 21: 2271-2279.
Crockett MT, Kelly BS, van Baarsel S, et al. Modic type 1 vertebral endplate changes: injury, inflammation, or infection? AJR Am J Roentgenol 2017; 209: 167-170.
Fardon DF, Williams Al, Dohring EJ, et al. Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J 2014; 14: 2525-2545.
Fardon DF, Milette PC. Combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Nomenclature and classification of lumbar disc pathology. Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine 2001; 26: E93-113.
Diehn FE, Maus TP, Morris JM, et al. Uncommon manifestations of intervertebral disk pathologic conditions. Radiographics 2016; 36: 801-823.
Wiltse LL, Berger PE, McCulloch JA. A system for reporting the size and location of lesions in the spine. Spine 1997; 22: 1534-1537.
Hartman J. Anatomy and clinical significance of the uncinate process and uncovertebral joint: a comprehensive review. Clin Anat 2014; 27: 431-440.
Weishaupt D, Zanetti M, Boos N, et al. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 1999; 28: 215-219.
Lattig F, Fekete TF, Grob D, et al. Lumbar facet joint effusion in MRI: a sign of instability in degenerative spondylolisthesis? Eur Spine J 2012; 21: 276-81.
Czervionke LF, Fenton DS. Fat-saturated MR imaging in the detection of inflammatory facet arthropathy (facet synovitis) in the lumbar spine. Pain Med 2008; 9: 400-406.
Liu SS, Williams KD, Drayer BP, et al. Synovial cysts of the lumbosacral spine: diagnosis by MR imaging. AJR Am J Roentgenol 1990; 154: 163-166.
Apostolaki E, Davies AM, Evans N, et al. MR imaging of lumbar facet joint synovial cysts. Eur Radiol 2000; 10: 615-623.
Nouri A, Martin AR, Mikulis D, et al. Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques. Neurosurg Focus 2016; 40: E5.
Lee MJ, Cassinelli EH, Riew KD. Prevalence of cervical spine stenosis. Anatomic study in cadavers. J Bone Joint Surg Am 2007; 89: 376-380.
Morishita Y, Naito M, Hymanson H, et al. The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine. Eur Spine J 2009; 18: 877-883.
Edwards VC, LaRocca H. The developmental segmental sagittal diameter of the cervical spinal canal in patients with cervical spondylosis. Spine 1983; 8: 20-27.
Aebli N, Rüegg TB, Wicki AG, et al. Predicting the risk and severity of acute spinal cord injury after a minor trauma to the cervical spine. Spine J 2013; 13: 597-604.
Pierro A, Cilla S, Maselli G, et al. Sagittal normal limits of lumbosacral spine in a large adult population: a quantitative magnetic resonance imaging analysis. J Clin Imaging Sci 2017; 7: 35.
Mamisch N, Brumann M, Hodler J, et al. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology 2012; 264: 174-179.
Lee GY, Lee JW, Choi HS, et al. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol 2011; 40: 1033-1039.
You JY, Lee JW, Lee E, et al. MR classification system based on axial images for cervical compressive myelopathy. Radiology 2015; 276: 553-561.
Park HJ, Kim SS, Lee SY, et al. A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images. Br J Radiol 2013; 86: 20120515.
Ulmer JL, Mathews VP, Elster AD, et al. MR imaging of lumbar spondylolysis: the importance of ancillary observations. AJR Am J Roentgenol 1997; 169: 233-239.
Yamaguchi KT Jr, Skaggs DL, Acevedo DC, et al. Spondylolysis is frequently missed by MRI in adolescents with back pain. J Child Orthop 2012; 6: 237-240.
Ganiyusufoglu AK, Onat L, Karatoprak O, et al. Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine. Clin Radiol 2010; 65: 902-907.
Johnson DW, Farnum GN, Latchaw RE, et al. MR imaging of the pars interarticularis. AJR Am J Roentgenol 1989; 152: 327-332.
Trout AT, Sharp SE, Anton CG, et al. Spondylolysis and beyond: value of SPECT/CT in evaluation of low back pain in children and young adults. Radiographics 2015; 35: 819-834.
Meyerding HW. Spondyloptosis. Surg Gynaecol Obstet 1932; 54: 371-377.
Dean CL, Gabriel JP, Cassinelli EH, et al. Degenerative spondylolisthesis of the cervical spine: analysis of 58 patients treated with anterior cervical decompression and fusion. Spine J 2009; 9: 439-446.
Filippiadis DK, Mazioti A, Argentos S, et al. Baastrup’s disease (kissing spines syndrome): a pictorial review. Insights Imaging 2015; 6: 123-128.
Chen CK, Yeh L, Resnick D, et al. Intraspinal posterior epidural cysts associated with Baastrup’s disease: report of 10 patients. AJR Am J Roentgenol 2004; 182: 191-194.
Ratcliffe JF. Anatomic basis for the pathogenesis and radiologic features of vertebral osteomyelitis and its differentiation from childhood discitis. A microarteriographic investigation. Acta Radiol Diagn 1985; 26: 137-143.
Mavrogenis AF, Megaloikonomos PD, Igoumenou VG, et al. Spondylodiscitis revisited. EFFORT Open Rev 2017; 2: 447-461.
Yeom JA, Lee IS, Suh HB, et al. Magnetic resonance imaging findings of early spondylodiscitis: interpretive challenges and atypical findings. Korean J Radiol 2016; 17: 565-580.
Ledermann HP, Schweitzer ME, Morrison WB, et al. MR imaging findings in spinal infections: rules or myths? Radiology 2003; 228: 506-514.
Moritani T, Kim J, Capizzano AA, et al. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections. Br J Radiol 2014; 87: 20140011.
Patel KB, Poplawski MM, Pawha PS, et al. Diffusion-weighted MRI claw sign improves differentiation of infectious from degenerative modic type 1 signal changes of the spine. AJNR Am J Neuroradiol 2014; 35: 1647-1652.
Ledbetter LN, Salzman KL, Shah LM. Imaging psoas sign in lumbar spinal infections: Evaluation of diagnostic accuracy and comparison with established imaging characteristics. AJNR Am J Neuroradiol 2016; 37: 736-741.
Darouiche RO. Spinal epidural abscess. N Engl J Med 2006; 355: 2012-2020.
Tung GA, Yim JW, Mermel LA, et al. Spinal epidural abscess: correlation between MRI findings and outcome. Neuroradiology 1999; 41: 904-909.
Trecarichi EM, Di Meco E, Mazzotta V, et al. Tuberculous spondylodiscitis: epidemiology, clinical features, treatment, and outcome. Eur Rev Med Pharmacol Sci 2012; 16: 58-72.
Smith AS, Weinstein MA, Mizushima A, et al. MR imaging characteristics of tuberculous spondylitis vs vertebral osteomyelitis. AJR Am J Roetngenol 1989; 153: 399-405.
Jung NY, Jee WH, Ha KY, et al. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. AJR Am J Roentgenol 2004; 182: 1405-1410.
Frel M, Białecki J, Wieczorek J, et al. Magnetic resonance imaging in differential diagnosis of pyogenic spondylodiscitis and tuberculous spondylodiscitis. Pol J Radiol 2017; 82: 71-87.
Rajeev A, Choudhry N, Shaikh M, et al. Lumbar facet joint septic arthritis presenting atypically as acute abdomen – a case report and review of the literature. Int J Surg Case Rep 2016; 25: 243-245.
Murthy NS, Maus TP, Aprill C. The retrodural space of Okada. AJR Am J Roentgenol 2011; 196: W784-9.
Doita M, Nishida K, Miyamoto H, et al. Septic arthritis of bilateral lumbar facet joints: report of a case with MRI findings in the early stage. Spine 2003; 28: E198-202.
Burton EC, Troxclair DA, Newman WP 3rd. Autopsy diagnoses of malignant neoplasms: how often are clinical diagnoses incorrect? JAMA 1998; 280: 1245-1248.
Yuh WT, Zachar CK, Barloon TJ, et al. Vertebral compression fractures: distinction between benign and malignant causes with MR imaging. Radiology 1989; 172: 215-218.
Lecouvet FE, Vande Berg BC, Maldague BE, et al. Vertebral compression fractures in multiple myeloma. Part I. Distribution and appearance at MR imaging. Radiology 1997; 204: 195-199.
Lecouvet FE, Malghem J, Michaux L, et al. Vertebral compression fractures in multiple myeloma. Part II. Assessment of fracture risk with MR imaging of spinal bone marrow. Radiology 1997; 204: 201-205.
Baur A, Stäbler A, Arbogast S, et al. Acute osteoporotic and neoplastic vertebral compression fractures: fluid sign at MR imaging. Radiology 2002; 225: 730-735.
Shih TT, Huang KM, Li YW. Solitary vertebral collapse: distinction between benign and malignant causes using MR patterns. J Magn Reson Imaging 1999; 9: 635-642.
Cuénod CA, Laredo JD, Chevret S, et al. Acute vertebral collapse due to osteoporosis or malignancy: appearance on unenhanced and gadolinium-enhanced MR images. Radiology 1996; 199: 541-549.
Kim DH, Rosenblum JK, Panghaal VS, et al. Differentiating neoplastic from nonneoplastic processes in the anterior extradural space. Radiology 2011; 260: 825-830.
Rupp RE, Ebraheim NA, Coombs RJ. Magnetic resonance imaging differentiation of compression spine fractures or vertebral lesions caused by osteoporosis or tumor. Spine 1995; 20: 2499-2504.
Mauch JT, Carr CM, Cloft H, et al. Review of the imaging features of benign osteoporotic and malignant vertebral compression fractures. AJNR Am J Neuroradiol 2018; 39: 1584-1592.
Arevalo-Perez J, Peck KK, Lyo JK, et al. Differentiating benign from malignant vertebral fractures using T1-weighted dynamic contrast-enhanced MRI. J Magn Reson Imaging 2015; 42: 1039-1047.
Sung JK, Jee WH, Jung JY, et al. Differentiation of acute osteoporotic and malignant compression fractures of the spine: use of additive qualitative and quantitative axial diffusion-weighted MR imaging to conventional MR imaging at 3.0 T. Radiology 2014; 271: 488-498.
Schmeel FC, Luetkens JA, Feißt A, et al. Quantitative evaluation of T2* relaxation times for the differentiation of acute benign and malignant vertebral body fractures. Eur J Radiol 2018; 108: 59-65.
Chen Y, Yu Q, La Tegola L, et al. Intravoxel incoherent motion MR imaging for differentiating malignant lesions in spine: a pilot study. Eur J Radiol 2019; 120: 108672.
Journals System - logo
Scroll to top